Guest column: Keep politics out of science

Sunday

Jul 14, 2013 at 9:45 AM

When the American Medical Association declared obesity to be a disease last month, they did it against the express recommendation of their own panel of subject-matter experts, who had been studying the issue for a year.

Benjamin Wachs

When the American Medical Association declared obesity to be a disease last month, they did it against the express recommendation of their own panel of subject-matter experts, who had been studying the issue for a year.

There are plenty of good reasons not to declare obesity a disease. The leading measurer of obesity (the body mass index) is widely known to be flawed. The negative health effects generally associated with obesity are actually better correlated with other factors - such as high blood pressure or high cholesterol - that not all obese people suffer from, and a number of non-obese people do. Not all obesity comes from the same cause or has the same results.

But the AMA had other reasons for declaring obesity a disease. According to the LA Times:

•They did it to change the way the health care system treats obese patients.

• They did it to put pressure on insurance companies to pay for obesity treatments.

•They did it to help primary care physicians "to get over their discomfort about raising weight concerns with obese patients."

According to the Pacific Standard, there were economic reasons for the decision as well:

"If everyone who has a BMI equal to or over 30 now has a disease, then doctors can get reimbursed to treat it as such. A disease that affects over one-third of the population will generate an expensive prescription to be filled. And everyone who is labeled ‘obese' will have a pre-existing condition, which can surely affect premiums."

And the New York Times added one more reason: "Some doctors and obesity advocates said that having the nation's largest physician group make the declaration would focus more attention on obesity."

That last one's absurd, of course: The last thing anyone needs is to "raise awareness" of obesity. If obesity got any more attention it would be running for president. Does anyone not know it exists? That it's a problem? That there's a "war" on it? But that aside, all these reasons sound good and helpful and worthwhile. Don't they?

Anyone who thinks that climate change must be a serious issue because the major scientific associations say so needs to remember that a leading scientific association just established a new disease for reasons that had nothing to do with science. The scientific evidence, their own experts told them, was against the classification. They made it anyway.

Now I'm not for a minute suggesting that evolution isn't real or that climate change isn't a significant threat. But anyone who thinks that science is an impartial arbiter of factual questions should be outraged by the way scientific organizations increasingly see their role as setting social policy and settling political arguments (or just lining their pockets), rather than presenting the public with the best scientific conclusions.

The American Psychiatric Association's treatment guidelines for mental illness (the DSM) have, as the National Institutes of Health recently recognized, no scientific basis ... at all. It's been a scandal for decades.

"Its weakness is its lack of validity," wrote NIH Director Thomas Insel. "DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure." Meanwhile the APA has refused to disclose whether the people who write its treatment guidelines receive funding from pharmaceutical companies.

And then there's medical schools, which have become so saturated with money from big pharmaceutical companies that it's impossible to say whether new doctors are studying impartial evidence about treatments or drug company propaganda.

Science, and scientists, are given special standing in public debate precisely because it's vital to democracy that the public have a clear understanding of what scientific evidence points to. That's a privilege that comes with a responsibility: to present the data, and the most reasonable conclusions, and then stop. But when scientific bodies make pronouncements because they want to change the insurance industry, it casts the whole enterprise of science as its practiced under suspicion.

To the extent scientific bodies are just one more lobbying group, one more arm of a political agenda, they're unnecessary.

It's not anti-science to point this out. When scientists make "scientific" determinations that go against the recommendations of their own subject matter experts, something has gone horribly wrong. The evidence about climate change, about evolution, about hundreds of vital issues we face, deserves better than that.

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